Sex-Specific Thyroid Dysfunction in Sulfur Mustard-Exposed Veterans With Different Injury Severity

Sulfur mustard (SM), a chemical warfare agent, has been linked to chronic health issues, including thyroid dysfunction. This study investigates the impact of SM exposure on thyroid function indices in men and women veterans, exploring sex-based differences and correlations with injury severity. A cross-sectional study was conducted involving 412 SM-exposed veterans (315 men, 97 women) and 113 healthy controls (79 men, 34 women). Participants were categorized by injury severity into three subgroups: 5%-10%, 15%-35%, and > 35%. Thyroid function indices (triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), thyroglobulin (TG), anti-thyroglobulin antibodies (anti-TG), and anti-thyroid peroxidase antibodies (anti-TPO), and T3 uptake) were measured. TSH and T3 uptake levels were significantly higher in SM-exposed women than in controls. In men, TG levels were significantly higher than in women in both SM-exposed and control groups, while anti-TG levels were lower. Additionally, anti-TPO levels were elevated in SM-exposed men compared with control men and SM-exposed women. TG levels increased in men across all injury severities compared with controls, with anti-TG levels decreased in SM-exposed men at all severities. Women showed elevated T3 uptake and TSH levels across all severities compared with controls. Effect size analysis confirmed significant increases of T3 uptake in women and TG levels in men. This study highlights sex-specific differences in thyroid dysfunction among SM-exposed veterans, with women showing signs of hypothyroidism and men exhibiting autoimmune responses. Injury severity further exacerbated these effects, emphasizing the need for gender-specific monitoring and intervention strategies for SM-exposed individuals.